miscarriage

It has been a busy, hectic, and emotional week. In fact we almost haven’t had time to process what happened last Friday.

Almost.

While I felt guilty in the moment, looking back I do not regret caving in the 11th hour and taking the home pregnancy test. Testing before the official test allowed us to leave early for our weekend of water sliding and cleared Friday night for much needed time to discuss the sad news and what would come next.

Our discussion that night was one of the most challenging in our marriage. Bill and I process bad news in different ways which often leads to disagreements during times when we should be most supportive of each other, like the night of a failed pregnancy test. Especially this failed pregnancy test.

After eight procedures, twenty embryos, one miscarriage, and putting all our hopes and money into the Celebrity Miracle Clinic for one full cycle, we were both reeling and not at all in a position to give to the other what was needed that night. The weight of a disappointment of that magnitude could crush even the most perfect of couples.

Because so much of the IVF process centers on me, it is easy for me to forget that we are both invested in this. We are both elated when we are at a peak and devastated when we are in a valley. I have often made the mistake of expecting Bill to be there to take care of me, to put me back together when I am falling apart, only to realize that he may not be whole himself. This was the case Friday night.

Adding fuel to the fire, we were not at all aligned with what we wanted to do next. I decided long ago we would go back to Celebrity Miracle Clinic for one more attempt at creating a baby with my own eggs. Who cares that we didn’t like our experience there? I reviewed statistics for the best clinics in the country and determined that Celebrity Miracle Clinic was the place to be for an old lady with egg quality issues who was serious about getting knocked up.

Bill, on the other hand, has a deep seeded dislike of Celebrity Miracle Clinic and suggested in a less than subtle way that we consider alternatives.

Cue massive, explosive argument.

Throwing a wrench into the recovery plans of a hormonal Type A infertile woman is bound to cause a wee bit of a problem. It was a long night. Hurtful things were said. The evening culminated in our holding each other at 2 AM seriously discussing whether or not we could go through IVF again at all.

In the physical world, some explosions are devastatingly destructive. Others are critical steps toward building something new and breathtaking, like an expansive tunnel to the other side of an enormous mountain. I feel that Friday night was creative destruction, the clearing of one set of ideas and mental debris that allowed us to find a new path through this huge obstacle in front of us.

The truth is I don’t care for Celebrity Miracle Clinic either. Take for example what happened Saturday. I went for my blood work at 6AM mountain time. At 12:41 PM a nurse from the clinic called me to see if I had done my blood work. I told her that I had. She was then supposed to call the lab and call me right back to give us the results. Five hours later, there was still no call and no results. I eventually called the after hours answering service and had to demand to speak to the on call nurse because I was told “lab results are only discussed during normal business hours.” After five phone calls I finally received a call back with the results of my long awaited pregnancy test.

This type of thing happens all the time at Celebrity Miracle Clinic, but I explain it away and suppress my feelings about it because they supposedly have the best lab and results in the country.

Bill’s suggestion that we consider going back to our old clinic, the one that gave us Spork, made me angry at first. But the more I thought about it, the more it made sense to me.

We initially went to Celebrity Miracle Clinic because we didn’t know if we were still making chromosomally normal embryos. While our old clinic can do genetic testing, they do it at an early embryonic stage that can damage the embryo to the degree that makes it less likely to survive and implant.

Celebrity Miracle Clinic uses technology that allows the embryo to be biopsied at a later stage and therefore does less damage to the embryo, using only a small number of cells from the part of the embryo that will become the placenta.

I debriefed with my Celebrity Miracle Doctor on Monday. He said that we had three genetically normal embryos that were of good quality and we were just “unlucky” this time.

Hmmm… maybe. Maybe it’s a little more than just bad luck.

In our cycle at Celebrity Miracle Clinic we had 5 embryos make it to the blastocyst stage. Of those five, the initial genetic test results came back with two embryos as genetically normal (euploid), one abnormal (aneuploid). The remaining two embryos had to be retested because the tests were inconclusive.

What? Retested? What does that mean?

That means Celebrity Miracle Clinic achieved a 40% failure rate on their amazing state-of-the-art testing and we had to do it again. After retesting, one embryo came back abnormal and the other embryo was Blob. In order to be retested he had to be warmed and biopsied a second time, removing even more cells from his 100 or so to support the test.

When Blob was frozen the first time he was a 5BA blastocyst which meant he was still in his shell. During the second biopsy he completely reanimated, expanded, and even shed his outer shell. Then he was flash frozen again.

After that he was never the same.

Embryos are supposed to fully expand after being warmed. In fact, re-expansion is the most important indicator for a successful implantation. Blob barely had a chance once he was warmed again and only slightly expanded.

What Blob looked like at transfer

What Blob should have looked like at transfer

Had the test worked the first time, or had Blob not been tested at all, he could be happily growing inside me. There is no way to know, but the testing could have been too much for him. It could have been too much for the other two normal embryos that didn’t implant in January as well.

My new/old clinic transfers embryos at an earlier stage, generally untested but also undamaged. Now that we know more than 25% of our embryos are likely to be chomosomally normal, we can go back to the new/old clinic and continue with some confidence that it will likely just be a matter of time and patience before one of those embryos sticks and becomes Spork’s sibling.

While we do run an increased risk of miscarrying an abnormal embryo that wouldn’t have been transferred at Celebrity Miracle Clinic, as well as an increased risk for Down’s Syndrome or other chromosomal issues, these risks aren’t higher than any other 38 year old who gets pregnant and are still relatively low. The trade off is that we put the embryos back to their natural environment without damage sooner, which bodes well for delicate embryos.

Armed with this knowledge, today we said goodbye to Celebrity Miracle Clinic. I sent the official form from new/old clinic requesting all my medical records. I called my nurse to tell her voice to voice. It felt a little like an overdue break-up, like severing a slightly dysfunctional but at one time mutually beneficial relationship that is no longer beneficial.

We said goodbye to more than just a clinic with that call today. At our first consultation with them back in July we were so filled with the hope we would wind up on the right side of their jaw-dropping statistics. We were mesmerized by their program and amazing facility. Today we are no longer awe-struck. We said goodbye to that child like wonder and the certainty that Celebrity Miracle Clinic would swoop in and fix what was wrong.

We also said goodbye to Blob today. Even though I knew at transfer he had a slim chance, I fully believed he would make it. The start of my period today underscored the fact that he did not, something I have known since Friday but becomes so real when this time comes, the time when a cycle officially comes to an end and a new one begins.

While a little saddened, we are also turning a page. I received a call with the plan from the new/old clinic today thus taking our first steps through the tunnel we blasted into our own personal mountain. While the pain of goodbye is still fresh if I dwell on it like the pain of a fresh break up, there is nothing like the promise of a new relationship to help the memory fade.

I have been thinking a lot about how I can write about our miscarriage and keep it “on the lighter side.” My primary hope for this blog is for it to be a safe place to come to learn about fertility treatment and our story without having to be burdened with sadness and loss.

There are so many positives to connecting with other women who toil against infertility, but one of the downsides is that when you are close to them you feel their pain as your own. Another is that it is easy to take other’s sad circumstances and fantisize unproductively about them becoming your own. Sometimes it is best to stay away from Dr. Google and his dark, foreboding staff.

Because I believe a positive mental state is critical to managing stress and optimizing odds of success, I decided to limit my interactions with chat rooms and boards in an attempt to surround myself with positive energy for this cycle. While I miss “my girls” tremendously, it has been easier to not be completely obsessed with fertility and of course has given me the time I need to share my story with you in a way I would want it to be shared with me.

The desire to try to lighten the load for you does create quite the conundrum as it relates to finding a way to talk about one of the single most painful events in my life. I am not sure its entirely possible, so take heed as you begin reading this post. I gave it my best shot for you. While the stars aligned in the last 24 hours to give me some great fodder for sewing at least a few seeds of humor around our loss, I am afraid I have failed you and that what follows is not very light at all. I do manage to pepper in just the tiniest bit of levity and a small amount of positivity.

If you read Blown Away yesterday you know that I am away from the loves of my life for work for most of this week. In fact, I didn’t expect to be able to post at all until Friday because of an intense series of meetings scheduled for today and tomorrow. Unfortunately I am not in a meeting and am posting from a bed in a hotel in Lansing where I am recovering from a terrible case of food poisoning that I suspect came from a bad piece of black cod. That will teach me to order fish in landlocked Lansing.

I say its unfortunate but I am not sure I really mean it, its almost better than being at that meeting. If you have ever had food poisoning, you know it is no joke and that this is a strong statement. There was a moment at about 3 AM when I seriously wondered if I was going to live to see today. However I have been poisoned by my grub twice before so I knew if I just hung in there I would eventually be on the other side of the worst of it. I am now there.

Thank. You. God.

And where I am now is NOT in a meeting room in downtown Lansing where I lost a pregnancy back in early July.

Thank. You. God.

Don’t get me wrong, I have been to that meeting room since July and will be there again. I am strong and would have made it through it and probably even enjoyed the meeting with my boss and peers. Probably. But not being there today is definitely a great big fat silver lining to a cloud that will always hang over that place for me. So thank you God for your sense of humor and thank you black cod for choosing the perfect time to poison me.

Our miscarriage story started back in February of 2013 when we began our first IVF cycle for baby number two. We tackled the process with a renewed faith in ourselves and IVF after having Spork the year before. Prior to the fourth transfer that ultimately gave us Spork I never would have thought I could go through another IVF cycle. She was what we needed to regain confidence that we could do it, we could go through it all again. It was worth it.

Our cycle went very well in the beginning. We retrieved more eggs and made more embryos than we ever had before, 10 embryos when it was all said and done. 10 embryos? There had to be a baby in there!

We transfered 3 in the fresh cycle 2 days following retrieval and did not get pregnant. We were disappointed but we were okay. Heck this might even be a good sign! After all we got pregnant on a frozen cycle with Spork and we know that some women do better with frozen cycles. We rationalized that I was one of those women and prepared for the inevitable success that was to come in May. Besides, if it had worked what in the world were we going to do with all those leftover snow babies?

When we discovered our transfer date was the day before Mother’s Day, we were positively beside ourselves with excitement. Spork was transfered to me on Mother’s Day in 2011 and we always considerred it part of the magic that brought our sweet baby girl to us.

Sadly, the magic faded for us after that. When we arrived at the transfer we learned that all 7 remaining embryos had to be thawed in order to get the three we were transfering. It was devastating. Our third chance was taken from us prior to the second chance from this cycle even really beginning. Then to add insult to injury the transfer went very poorly. Having a “smooth” transfer dramatically improves success rates and our transfer was anything but. The reason for this is that I am somewhat anatomically challenged in terms of the way my plumbing is situated. I will spare you the details, but suffice it to say I am difficult for the doctor to navigate. Despite knowing this, he made the mistake of sending his sonographer home and tried to wing it with a nurse. I presume he did this because it was Saturday and we were the last transfer on the schedule. Not cool. Transfer normally takes about 5 minutes and this one took over 20 and involved the doctor yelling and sweating profusely. So not cool.

When we left we wondered if the embryos even made it to the sweet spot and whether there was any chance I could be pregnant from this doozie of a cycle. I was fighting back tears and Bill was shell shocked and angry. So you can imagine our surprise just a few days later when I saw that first little faint hint of a line on the home pregnancy test. Hell yeah! Who needs those other 4 embryos anyway? Our doctor went from zero to hero in a matter of seconds. All that sweating and yelling paid off and he had nailed it.

When the blood test was done a few days later we were stoked to have the confirmation for the home pregnancy test. Our beta HCG level was 60, not too high but certainly high enough to feel reasonably confident we had a healthy pregnancy starting. Two days later it only went to 100. Beta HCG levels are supposed to double every 48 to 72 hours, so this was concerning but did not mean we were out of the game yet. It was right at the outer limit. We waited another 4 days and the levels only went to 160. Uh Oh.

But then 4 days later the levels took off and did exactly what they were supposed to.

Yes! Yes! Yes! We were still worried but hoped that there was a vanishing twin skewing the numbers in the begining and that all would be well from here on in the process.

Because of our slow start we continued to monitor the Beta HCG levels every 2 to 4 days and went in for an ultrasound at 5 1/2 weeks. The ultrasound showed a small gestational sac which was a little on the slow growing side but still had the potential to become a bonafide bouncing baby. We took off the next day for a week in Northern California to attend Bill’s 20th highschool reunion. Having been pregnant before, I could tell toward the end of the trip that something was off but still held out hope that we would see a heartbeat when we returned and had our our next ultrasound. I faithfully awoke to take my progesterone shots at 3 AM Pacific every day (I defintelyshould have planned my shot time better in light of the trip). I abstained from all alcohol on a trip that was infused with it. I caught myself rubbing my belly in anticipation. We couldn’t wait to get back and find out the results.

The day after we returned home we had the fateful ultrasound that showed at 7 weeks we still only had a small empty sack that measured only 5 weeks and 4 days. There was no fetal pole or yolk sac. Nothing to indicate this pregnancy had the potential to become Spork’s sibling. It was time to stop the meds and hope that my body expelled the pregnany rather than needing a medical intervention to remove it.

When this happens you don’t know when or if you are going to lose the pregnancy naturally so its not as if life can stop while you wait to see what happens. As fate would have it, I lost my pregnancy at exactly 8 weeks over the course of a full day meeting with my boss and peers in that meeting room in Lansing. The one I am supposed to be in right now. It was physically painful. Nobody prepared me for the physical pain. I took 3500 mg of Tylenol over the course of the meeting and unsuccessfully fought back tears the whole day (I didn’t learn until later that this was a dangerous dose of Tylenol, so don’t do this!). After the meeting concluded I had to drive 3 1/2 hours home. There was really nothing very funny about that day. The process of losing the pregnancy continued for nearly a month, but the worst of it happened on that one day in that room.

Once again, shortly after the loss fate intervened to make life a little bit easier for me. My boss’s territory grew which required us to move our monthly meetings to Kalamazoo. Thanks boss! Yes it means more work and travel for him, but I have to believe that its all in service of keeping me away from that meeting room. The one that I will fight back tears everytime we take a break as I open the door to that women’s room where I lost a little part of me.

This month we had to move the meeting back to Lansing, just this one month. Of course in reality I would prefer to be there right now. But there is no way I could sit through a meeting given how I feel. Instead I will take the good with the bad. I am sure I will be back to normal tomorrow which is just fine. I won’t be facing any demons. Fortunately the meeting tomorrow has a bigger audience and will be right downstairs in this hotel.

Ironically, the timing of the cod attack was good for more than just keeping me from opening up that old wound in a very public and challenging setting. One of the silver linings I can’t really talk about. It involves someone I am close to receiving some incredibly shitty but not devastating news that kept me in tears in between trips to the bathroom last night. You know who you are and I love you. Today I am able to deal with that in a way I couldn’t in any meeting room, let alone the one in Lansing.

Also, I took a single dose of an important medication this morning that I was more than a little concerned about taking while in meetings this week. It’s a medication that my new doctor gave me to help me avoid a difficult transfer like the one described in our miscarriage story. The drug is called cytotec and it is the same medication in the same dosage that is used to soften the cervix and induce labor. So I am having small contraction like pains today. These pains will help make it easier to get to the sweet spot on March 13th. Better here than there in that room, that is for sure.

So this afternoon I found myself unexpectedly stuck in a hotel room surrounded by memories, feeling similar phiysical pains as to those of miscarriage, and reeling from a lost battle against a gnarly piece of fish. And amazingly, I was starving. I had no choice but to try to order room service from the very same kitchen that served up that horrible fish last night.

Since I am gluten free I was very skeptical that I would be able to eat at all today. When I called to ask what the soup de jour was, I had a little giggle when they told me it was Chicken and Rice. Not Chicken Noodle. Chicken and Rice. Chicken Noodle just would not do for a sick girl who doesn’t eat gluten. I couldn’t think of a more perfect lunch for a day like today even if it did have to come from Hell’s Kitchen.

It was exactly what I needed. A little Chicken and Rice Soup for the gluten-free soul.

Yes God. I see you smiling on me today through those heavy storm clouds. Thank You. Thank You.